Risk Factors for Weight Gain Following Switch to Integrase Inhibitor-Based Antiretroviral Therapy
Risk Factors for Weight Gain Following Switch to Integrase Inhibitor-Based Antiretroviral Therapy
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DOI：
10.1093/cid/ciaa177
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发表时间：
2020-11-01
影响因子：
11.8
通讯作者：
Erlandson, Kristine M.
中科院分区：
文献类型：
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作者：
Lake, Jordan E.;Wu, Kunling;Erlandson, Kristine M.
背景整合酶链转移抑制剂（INSTI）治疗开始与体重过度增加相关。在病毒学抑制的人群中，转换为INSTI后是否也能看到类似的获益尚不清楚。我们评估了艾滋病临床试验组参与者（A5001和A5322）在接受第一次免疫治疗前后的体重变化。纳入了1997-2017年随访并转为基于INSTI的抗逆转录病毒方案的参与者。分段线性混合效应模型调整了年龄、性别、人种/种族、基线BMI、最低值和当前CD 4（+）T细胞计数、吸烟、糖尿病和随访时间，抑制HIV-1 RNA检查了首次转换为INSTI前后的体重和腰围变化。线性样条模型与一个单一的节点在时间的开关占非线性趋势。972名转换为INSTI的参与者中81%为男性，50%为非白人，转换时的中位年龄为50岁，CD 4（+）T细胞计数为512个/μ L，BMI为26.4 kg/m2。仅限于转换时HIV-1 RNA受抑制的患者（n = 691），女性、黑人和≥ 60岁的患者在转换后2年内的体重增加比转换前更大。在调整后的模型中，在女性中，转换时的白色或黑色人种、年龄≥ 60岁、BMI ≥ 30 kg/m2与转换后体重增加相关;在男性中，年龄≥ 60岁是最大的风险因素。腰围的趋势相似。转换为INSTI后，年体重增加增加，特别是女性，黑人和年龄≥ 60岁的人。腰围的同时增加表明体重增加与脂肪量增加有关。
Background. Treatment initiation with integrase strand transfer inhibitors (INSTIs) has been associated with excess weight gain. Whether similar gains are seen after switch to INSTIs among virologically suppressed persons is less clear. We assessed pre/post-INSTI weight changes from AIDS Clinical Trials Group participants (A5001 and A5322).Methods. Participants who were in follow-up from 1997-2017 and switched to INSTI-based antiretroviral regimens were included. Piecewise linear mixed-effects models adjusting for age, sex, race/ethnicity, baseline BMI, nadir and current CD4(+) T-cell count, smoking, diabetes and follow-up time with suppressed HIV-1 RNA examined weight and waist circumference change before and after first switch to INSTIs. Linear spline models with a single knot at time of switch accounted for nonlinear trends.Results. The 972 participants who switched to INSTIs were 81% male and 50% nonwhite with a median age at switch of 50 years, CD4(+) T-cell count 512 cells/mu L, and BMI 26.4 kg/m(2). Restricting to persons with suppressed HIV-1 RNA at switch (n = 691), women, blacks, and persons >= 60 years experienced greater weight gain in the 2 years after versus before switch. In adjusted models, white or black race, age >= 60, and BMI >= 30 kg/m(2) at switch were associated with greater weight gain following switch among women; age >= 60 was the greatest risk factor among men. Trends for waist circumference were similar.Conclusions. Yearly weight gain increased following switch to INSTIs, particularly for women, blacks, and persons aged >= 60. Concomitant increases in waist circumference suggest that this weight gain is associated with an increase in fat mass.